DO CLINICAL AND FORMAL ASSESSMENTS OF THE CAPACITY OF PATIENTS IN THEINTENSIVE-CARE UNIT TO MAKE DECISIONS AGREE

Background: The complex environment and technology of intensive care u nit (ICU) care may impair the ability of patients to participate in me dical decision making or give informed consent. We studied the agreeme nt of the intuitive assessments of residents and nurses of ICU patient s' cognition, judgment, and decision-making capacity, and whether thos e assessments agreed with abbreviated formal mental status testing. Me thods: Using a prospective survey case study, we assessed 200 English- speaking patients within 24 hours of their ICU admission. Formal asses sment of cognition, judgment, and insight was performed by a research assistant. We obtained independent intuitive ratings by nurses and res idents of patient cognition, judgment, and ability to participate in m edical decision making or give informed consent. Results: Residents' a nd nurses' assessment of cognition and judgment showed a high degree o f agreement with weighted kappaS of greater than 0.76, Assessments of cognition by residents and nurses agreed with Folstein Mini-Mental Sta te Examination in 70% and 73.6% of cases, respectively. Forty percent of the population had an unimpaired Mini-Mental State Examination scor e of greater than 23, and an additional 12% of the subjects were mildl y impaired with scores of 20 to 23. When asked whether they would appr oach patient or family for consent for an invasive procedure, nurses a nd physicians said they would request informed consent from 66% and 62 % of the patients, respectively. Conclusions: Residents and nurses car ing for patients newly admitted to the ICU agree in their assessment o f cognition, judgment, and capacity to participate in medical decision making, and are not unduly influenced by ventilator status. Their ass essments correlate highly with abbreviated formal mental status testin g.